Hospital Patient Care Initiative Voting Form
Review and vote on proposed initiatives to improve patient care at our hospital.
Full Name
*
First Name
Last Name
Your Role
*
Please Select
Nurse
Physician
Administrator
Patient
Family Member
Other
Department / Unit (if applicable)
Email Address
*
example@example.com
Please review the following patient care initiatives and vote for the one you believe will have the greatest positive impact.
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Implement bedside shift reporting
Expand patient education programs
Enhance pain management protocols
Improve discharge planning process
Increase family involvement in care
Other (please specify below)
If you selected 'Other', please specify the initiative.
Please rate the importance of each initiative below.
*
Rows
Not Important
Somewhat Important
Important
Very Important
Bedside shift reporting
1
2
3
4
Patient education programs
5
6
7
8
Pain management protocols
9
10
11
12
Discharge planning process
13
14
15
16
Family involvement in care
17
18
19
20
How satisfied are you with current patient care practices?
*
1
2
3
4
5
What suggestions or comments do you have regarding patient care initiatives?
Would you like to participate in future discussions or committees about patient care initiatives?
*
Yes
No
Submit Vote
Should be Empty: